Orthodontic & Dental Clinic
IInd Floor, B.A. Centre Point,
Next to Taj Mahal
Signal Light Junction, Hampamkatta,
Mangalore - 575001
Email: rohanmasc@yahoo.com | Phone: 0824-2428908/4265408 (Clinic) 0824-2415408/2417508 (Residence)
 
 
 
 
 
 
 
 
 
 
 
 
 
   
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    Patient Info: INSTRUCTIONS    
     
     

    Eating Habits after braces are placed
     
    Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth.You know that your confidence about your teeth affects how you feel about yourself, both personally and professionally.
     
    We rocommend that you cook your vegetables before you eat them. Also cut corn off the cob, meat off the bone and fruit (such as apples) into small bite size pieces.
    Please do not use your front teeth to bite into anything that may damage your braces.
    Delicate non-sticky dishes should be your dishes of choice at first. Further, fight the urge to eat out at restaurants before you get totally used to having braces in your mouth.
    Remember to brush after each meal or snaks and floss at least once daily.

    Brushing
    What is the best technique for brushing?

    There are a number of effective brushing techniques. Patients are advised to check with their dentist or hygienist to determine which technique is best for them, since tooth position and gum condition vary.
    One effective easy-to-remember technique involves using a circular or elliptical motion to brush couple of teeth at a time, gradually covering the entire mouth.

    Place a toothbrush beside your teeth at a 45-degree angle and gently brush teeth in an elliptical motion.

    Brush the outside of the teeth, inside the teeth your tongue and the chewing surfaces and in between teeth.

    Using a back and forth motion causes the gum surface to recede, or can expose the root surface or make the root surface tender. You also risk wearing down the gum line.

    How long should I brush?
    In general, a toothbrush head should be small (1"by 1/2") for easy access.
    It should have a long, wide handle for a firm grasp.
    It should have soft, nylon bristles with round ends. Some brushes are too abrasive and can wear down teeth.
    A soft, rounded, multitufted brush can clean teeth effectively.
    Press just firmly enough to reach the spaces between the teeth as well as the surface.
    Medium and hard bristles are not recommended.

    How long should I brush?

    It might be a good idea to brush with the radio on, since dentists generally recommend brushing 3-4 minutes, the length of an average song.

    Using an egg timer is another way to measure your brushing time.

    Patients generally think they're brushing longer, but most spend less than a minute brushing.

    To make sure you're doing a thorough job and not missing any spots, patients are advised to brush the full 3-4 minutes twice a day, instead of
    brushing quickly five or more times through the day.

    The following tips may improve your work-time brushing habits:
     
    Post a sticky note on your desk or computer at work as a reminder to brush your teeth after lunch.
    Brush your teeth right after lunch, before you become absorbed in work.
    Store your toothbrush and toothpaste at work in a convenient and handy place.
    Make brushing your teeth part of your freshening up routine at work
       

    Headgear Treatment
     

    Wear the appliance from 10 to 12 hours, or as you have been instructed.

    Some temporary discomfort may be experienced during the first night or two. Molar teeth may become tender and even a little loose. Falling asleep may by difficult.

    Once you start headgear treatment, you must keep it up continuously. Wear the headgear everyday and all night. If you leave it off for just one night, you may have to wear it MANY EXTRA NIGHTS and extend your treatment unnecessarily.

    Use a "score card" to keep account of the number of hours you wear the appliance
    each day and night. THIS IS IMPORTANT!

    Don't Goof! Remember- it is your future in which we are interested.

    Please do not wear your headgear during rough play and sports. This could result in
    injury to you.
    Types of Headgear:

    "NECK" HEADGEAR
     
    Handle everything carefully, especially when removing or inserting the inner bow. Never, we repeat, never try to pull the headgear off without first unhooking the elastics or the strap, which is attached to the outer bow.
    Protect the bow when not in use by keeping it, with neck strap, in a container. If the bow is lost or distorted, call us immediately.
    Store your toothbrush and toothpaste at work in a convenient and handy place.
    If a band, which is cemented to a tooth becomes loose, call for an urgent appointment. Bring the band and all other materials with you of course.

    "J" HOOK HEADGAR
     

    This type is designed to lift front teeth back and into the upper jaw.

    Each side slides onto small hooks provided on the archwire that is tied to your bands and teeth. The outer bows on each side rest lightly along the cheek and enter at the corners of the mouth. Replace elastics as directed. Of Course never wear your headgear any time you are roughhousing or playing any game when it might be grabbed by a playmate.
    BRING ALL PARTS OF YOUR HEADGEAR TO THE OFFICE ON EACH VISIT

    FACEMASK -What is it?
     
     
    Facemasks are designed to bring individual teeth, groups of teeth or entire arches forward. It is also used to slow down the growth of the lower jaw and promote growth of upper jaw.

    Your part:
     
    Wear the appliance from 12 to 14 hours per day or as much as possible when you are at home.
     
    You may experience some initial discomfort. Take what you would normally take for a headache, if you wish, to help with discomfort.
    When worn on a regular basis, wearing the appliance will become easier and more comfortable.
    Do not wear appliance during rough play, sports or any time it may be pulled off. This could result in injury to you.
    Always be sure you have plenty of rubber bands before you leave the office. Know the "name" of your rubber band.
    If you are running short of rubber bands, call the office. We can mail you some.
    Use chin pads provided or use a stretched out cotton ball.

    Removable Orthodontic Appliances
     

    Instructions for Wear and Care of Removable Orthodontic Appliances

    If you follow these suggestions your appliances will work best for you and will lessen the time you have to wear it.

    Wear it all day and night exactly as instructed by your doctor.

    Brush your teeth AND your appliance after each meal.

    You may clean the appliance with soap and water or toothbrush and toothpaste. NEVER place it in hot or boiling water after cleaning. DO NOT use bleaches on it.

    With a new appliance, there may be an initial difficulty in speech and a plastic taste from the appliance; both should disappear in a day or two. Also, some saliva may be present at first, but this soon returns to normal.

    When you are not wearing the appliance, keep it in the plastic box and carry it with you. Be especially careful to keep it away from pets that may like the smell and damage it by chewing.

    Do not use your tongue to flip or play with the appliances. This will loosen it. Sticky foods such as gum, caramels, or taffy should be avoided, as they too will loosen the fit.

    It is our custom to charge an additional fee for lost or broken appliances.
       

    Tongue and Lip Exercises
     
     
    For the Correction of Abnormal Swallowing
    Instructions for correct swallowing:
    Close the back together.
    Place the tip of the tongue against palate or gum ridges.
    Suck tongue up flat against roof of mouth; slide tongue back with sucking action.
    Swallow
    Again close teeth firmly, close lips easily, tongue flat against roof of mouth, suck hard and swallow
     
       

    Remember
     

    Use mirror to watch for facial movements when practicing.

    Muscles around mouth are completely relaxed when swallowing.

    Brush your teeth AND your appliance after each meal.

    Never curl tongue

    Practice on small bits of food and small swallows of liquid. Do not blow, but suck when swallowing. Keep lips closed tightly, use card or wax paper between lips as reminder to keep lips closed.

    Repeat the above many times a day and following exercises to learn to swallow correctly.

    Lick the palate or gum ridges many times each day.

    Place the tip of the tongue on the palate or gum ridges and keep it there while studying, playing, watching television or in school.
       

    Night Time Suggestions
     
    Place the tip of the tongue on palate when you go to bed and try to keep it there.
    When you awaken in the morning again place tip of tongue on palate.
     
    Follow the above basic steps of swallowing when you eat breakfast, lunch, snacks and dinner.
       
      Always think of the four basic steps used in correct swallowing whenever you eat or drink.

    Orthodontic Elastics
     

    During treatment you will be given elastics to wear to help move your teeth. They may change in size, pressure and the way you place them on your teeth. This is a special time in your orthodontic treatment where you have additional control over how well your treatment progresses.
     
    Your treatment will progress the best if you follow these instructions :
    Wearing your elastics correctly is very important to keep your treatment going in the right direction. Make sure you are wearing the correct size and attaching them as you are instructed. You may experience discomfort at first, however, as you wear your elastics continuously that should disappear.
    Wear your elastics all the time unless we tell you differently.
    You may remove them while you are brushing your teeth and eating.
    Make sure to replace them immediately.
    Replace your elastics if they break and change them as we tell you. This will usually be at least once per day.
    Always carry extra elastics with you so you can replace broken ones right away.
       

    Hawley Retainer Instructions
     

    The retainer must be worn at all times for the first week, except when eating or brushing or swimming. Afterwards, every night!

    It is natural to experience fullness in your mouth with a new retainer. The feeling will go away after 1-2 days as you wear your retainer full time.

    It is natural to experience difficulty in talking at first. With a little practice, it will gradually improve.

    Expect to have an excessive flow of saliva at first.

    The plastic taste is a bummer, but it will disappear in a few days. You can soak the retainer in mouthwash to help.

    You should brush the retainer inside and out at least two times a day with a toothbrush and toothpaste. Soaking it in a retainer or denture cleanser is recommended.

    To prevent loss or breakage, the retainer should be kept in a plastic retainer case whenever it is out of your mouth. Keep your retainer and its case away from dogs, cats and little brothers. They can be destroyed in a hurry.

    By far, the number one reason for losing retainers is by wrapping them in napkins and leaving them in restaurants. Many hours have been spent looking through trashcans for retainers. Please don’t let this happen to you.

    There is a minimum charge of $230.00 - $250.00 to replace a lost or broken appliance; however, depending on the type of appliance will determine the final fee. Please, BE CAREFUL!

    Soreness and sensitivity of teeth are quite common the first few days. Irritation of gums, cheeks or lips should disappear within 3 to 4 days; if they persist, phone the office for an appointment.

    If any wire should be accidentally bent or broken, call the office for an appointment as soon as possible.

    CAUTION: DO NOT PUT YOUR RETAINER IN BOILING WATER OR LEAVE IN SUNSHINE, HOT CARS, DON’T PLACE IN DISWASHERS, MICROWAVES, AS THESE WILL CAUSE IT TO WARP AND WILL NEED TO BE REPLACED.
       

    Post Orthognathic surgery instructions
     
     
    RECOVERY ROOM
     
    After the surgical procedure, you will be taken to the recovery room. You may or may not remember your stay here. When you first wake up you will become aware of certain things. First, your jaws will be held together with elastics. Sometimes this can cause some anxiety in patients, but relax. You are in no danger. Try not to open your jaws against the elastics. Secondly, you may have a tube inserted in your nose which may be slightly irritating. This is to remove anything from your stomach to reduce the incidence of nausea. We will remove this tube when the oozing has stopped. Your head will often be wrapped in a "cold ice pack". This pack is connected to a machine that automatically pumps cold water continually into the pack around your jaws. This takes the place of the ice pack and ensures that it is always cold and doesn't create the wet drippy mess that comes with ice packs. You will also have a face tent that has humidified oxygen coming out of it and you may have a urinary catheter in place.
    You will experience some nasal stuffiness and feel like you have a sore throat for a few days. This is from the intubation and is very common.. It will resolve within a few days.
    After approximately an hour, you will be discharged from the recovery room up to the hospital floor.
         

    Post Orthognathic surgery instructions
     
     
    IN-HOSPITAL STAY
     
    During your stay in the hospital, you will be under the care of nurses who are very well trained and experienced in handling orthognathic surgery patients. You will be closely monitored at all times. If you or your family have any questions or concerns, please do not hesitate to contact the nursing staff.
    At the hospital bedside, there will be a suction apparatus set up for you to suction out your mouth. Your head will be elevated and we will continue with the cold ice pack as described above. This will help decrease the swelling.

    You will be on several medications intravenously. Pain medication is administered through what is known as Patient Controlled Analgesia machine or PCA. This is controlled with a button that you can push when you need more pain medication, so there is no need to have to contact a nurse. The machine has a “lock out” control on it to reduce the risk of accidentally overmedicating. You will also have post operative antibiotics administered through the intravenous line as well as some medication to minimize your swelling.

    You can begin to drink clear fluids after we remove the nasal tube. It may be challenging because in addition to the swelling, your lips will feel numb. The nursing staff will assist you in drinking by giving you some aids to help you drink. This will consist of a long tubing with a large syringe attached to it. Draw up the fluids you want to drink in the syringe and twist the end of the tubing onto it. Insert the tubing along side your teeth until the end reaches the back of your cheeks. Now depress the plunger on the syringe and you should feel the liquid in the back of your mouth. You will also receive fluids in a zip lock bag that has a straw attached to it. You can squeeze the bag to help delivery of the fluids at a rate which is comfortable to you. Once you have mastered the clear fluids and we can progress to a full liquid diet which will also include shakes.

    It is important to try to drink early. The most common reason for delayed discharge is because the patient is not drinking adequate volume of fluid. You should aim to have about 2-3 liters of fluid intake per day.
    Patients often comment that they have nasal congestion after the surgery. This is temporary and you can use nasal spray that is prescribed for you. Try not to blow your nose if you have had upper jaw surgery. The nostril can be cleaned with Q-tips and diluted hydrogen peroxide if necessary.
    After the first day, you will be encouraged to not only sit up in a chair, but to actually ambulate down the hallway. Discharge is determined when the patient is adequately taking in enough fluids and the pain level is controlled with oral pain medication.

    Just a final word regarding your jaw surgery and safety. First, the elastics can be easily removed by you. In the unlikely event vomiting occurs, it is most important to position yourself properly rather than to try to take the elastics off. If you are sick, position yourself over a basin or toilet bowl and let the fluids pass between the spaces in your teeth and out your nose. You will not choke. For your safety, the hospital will discharge you with wire cutters or scissors which you should carry on you at all times.
         

    DISCHARGE TO HOME
     
     
    MEDICATIONS
     
    Prescriptions for medications post operatively will be given to you before the surgery. They will all be in liquid form The level of pain is surprisingly low following this surgery. In fact, we discharge patients with the same medication we use for our third molar surgery patients! Usually the pain is very well controlled with a common pain medication
    You will also be prescribed liquid antibiotics. Remember that often liquid medication is prescribed for children so you will need to take relatively more. Be sure to follow the instructions carefully.
         

    DIET
     
     
    IMMEDIATELY FOLLOWING SURGERY UNTIL WEEK 4:
     
    When you first arrive home after the surgery, the swelling and the numbness will make eating/drinking difficult. During this period, it is helpful to make the food/drinks a bit thinner. We advise patients to be creative about what they eat. Put foods through a blender or a food processor. It is sometimes difficult to find foods already in the liquid form, so creating your own pureed diet is helpful. Nutritional supplements are also helpful,
    In order to get an adequate volume of fluid and nutrition daily, it is usually necessary to eat smaller meals 5-6 times per day instead of the usual 3 times per day. We advocate “grazing” throughout the day.
    After the splint is removed, there will be progressive times during your recovery that the elastics are allowed to be removed. Resist the urge to chew at this point. It must be remembered, however, that the bones are not completely healed and are being stabilized only by the screws and plates. Therefore, we discourage actual chewing and encourage a gradual progression of movement and use of the jaws, keeping in mind that adequate healing does not take place until approximately 8-12 weeks.
         

    WEEKS 4-6:
     
     
    Food during this period does not need to be liquid. It can consist of soft foods that require minimal chewing. This can consist of mashed potatoes, scrambled eggs, soft pasta that is cut into small pieces, soft rice dishes, or soft sandwiches that are cut into small pieces. One can also eat the foods that were eaten during the initial period. Chewing can start during this period of time.
         

    AFTER WEEK 6:
     
     
    At this point, chewing can be attempted. The food must be initially soft, progressing into softer meats such as hamburger and soft chicken. The portions should be small so as not to place too much force on the healing bones. Soft fish dishes are also excellent.  You will find that your jaw will tire easily. This will continue for the first 2-3 months until your jaw muscles have accommodated for your new jaw position. Avoid eating food which requires chewing for prolonged periods of time.
         

    AFTER WEEK 6:
     
     
    At this point, chewing can be attempted. The food must be initially soft, progressing into softer meats such as hamburger and soft chicken. The portions should be small so as not to place too much force on the healing bones. Soft fish dishes are also excellent.  You will find that your jaw will tire easily. This will continue for the first 2-3 months until your jaw muscles have accommodated for your new jaw position. Avoid eating food which requires chewing for prolonged periods of time.
         

    SURGICAL SPLINT
     
     
    The surgical splint is custom made for your new bite. It has indentations on it that fit the teeth on the top and bottom and thus will only fit one way. Generally, the splint will be worn continuously for the first 2 weeks following surgery. Doctor will remove the splint after that time. The splint will also help reduce jaw joint pain.
         

    JAW OPENING
     
     
    Since jaw surgery causes soreness in the muscles and bones of your face, you will find some difficulty in moving your jaw normally after the splint is removed and we begin jaw movement. We will instruct you when it is time to begin proper jaw exercises. We do not recommend any specific exercises during the first week or ten days after your surgery. A Simply attempting to move your jaw side to side and opening slightly when you have your elastics off may help increase your jaw movement.
         

    HYGIENE
     
     
    As with any surgical wound, it is extremely important for you to keep all areas inside your mouth clean after surgery. Often patients find it useful to purchase a WaterPik device. You should brush your teeth (use the toothettes or a small kids' toothbrush) and rinse your mouth each time after you eat. The elastics and the wires from the braces entrap a lot of food debris, so cleaning is essential. Since you will most likely be eating small meals five or six times a day, you will need to clean your teeth at each of these intervals. Rinse with warm salt water (1 tsp salt in a warm glass of water) at least four times a day. The incision sites are above the gumline so brushing your teeth will not be a problem. If you use the curved syringe we give you, put it on each and every bracket to blast food particles out. If you have a waterpik, use it on the gentlest setting.
    REMEMBER: The importance of cleaning your teeth and mouth cannot be overemphasized. This must be done several times each day to keep the mouth and incision sites clean. This will help the wounds heal quickly without getting an infection.
         
     

    RETURNING TO WORK
     
     
    We usually advise taking between 2-3 weeks off before returning to work or school. This period may be shorter or longer in certain cases.  You feel somewhat tired after your jaw surgery initially, but with good nutrition your energy level will soon return to normal.  REMEMBER: IT TAKES 6 TO 8 WEEKS FOR INITIAL HEALING OF YOUR JAW OR JAWS AND 3 TO 4 MONTHS FOR A FULL BODY HEALING.  If the jaw is hit or bumped early after your surgery, this may cause some shifting in the jaw and bite, SO BE CAREFUL!
         
     

    PHYSICAL EXERCISE
     
     
    You can resume light physical exercise as soon as you feel able following your surgery. You should NOT participate in any exercise or sports that may involve hitting your jaw. These will include ALL CONTACT SPORTS, ANY SPORT INVOLVING A BALL, OR OTHER AGGRESSIVE SPORTS. You can resume light aerobic exercise, swimming, or running, as soon as you are able. Do not clench or stress your jaw muscles with heavy lifting or activity.
    If you have had a bone graft from your hip area then you should resume any physical activity slowly and carefully. It may take 2-4 weeks before the hip area feels comfortable with exercise.
         
     

    BLEEDING
     
     
    It is normal to experience some bleeding from the mouth for the first 7-10 days after jaw surgery. This should not, however, be excessive.  It will usually stop within a few minutes. With upper jaw surgery you may experience some old blood from the nose for the first week after surgery. This will usually happen as you stand or bend over. If bleeding is more than just a slow oozing, go immediately to the nearest emergency room and contact doctor. This, by the way, is very rare. Do not blow your nose for the first 3-4 weeks following surgery.
         
     

    X-RAYS
     
     
    X-rays will be required after your surgery. These will be typically done within the first few days after your surgery, then at three months, six months, and one year.

    We hope that these postoperative instructions have been helpful for you. We encourage all patients to read these instructions at least once prior to surgery and keep them on hand for reference during the first week after their surgical procedure.  We would also encourage family and friends who are involved in your care to read these instructions as this will help them make educated decisions regarding your care.  Please contact our office at any time with questions that are not clarified in this pamphlet.
         
     

    Scheduling Information
     
     
    Our main concern is to provide quality orthodontic treatment in a caring, professional setting. If we try to see our patients in just a small segment of our workday, we find that we are unable to meet our professional goals.

    Most appointments are less than one-half hour long. We do respect your time and try to schedule so that there is minimal waiting time.

    Almost all of our parents ask if it is possible to see their child before or after school. This is understandable but also impossible.

    During the school day, there may be classes that can be missed one time per month without any negative effect on a child's education. There will also be In-Service days and those are good times to try and schedule an appointment. Perhaps the benefit of allowing us to complete the orthodontic care to the best of our ability will far outweigh any inconvenience.

    Appointments in the middle of the day and during your lunch hour are easier to make and are more efficient for your time. The parking is also easier to find and traffic is lighter.
    We make a strong commitment to you and your family. Please allow us the opportunity to completely fulfill it.
     
     
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